3 Myths About Bupropion: Page 2 of 2

Those studies were done in patients with anxious depression, but what about patients with a separate anxiety disorder. Here bupropion may not fare as well, unless that anxiety disorder is the generalized type (GAD). In GAD, bupropion performed just as well as escitalopram (Lexapro) in a small head-to-head controlled trial.6 However, bupropion has failed in very small trials of panic disorder, post traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

Another Myth (#4): Bupropion isn’t a good fit for patients with insomnia

This one is partly true. Bupropion (along with desvenlafaxine) does carry a higher risk of causing initiation insomnia than the other antidepressants, but the difference is very small. Most second-generation antidepressants can cause insomnia, and the rates are similar.7 However, sleep quality is a different matter, and here bupropion shines. Depression impairs sleep architecture in several ways. There is more REM latency (the patient enters REM too quickly), REM density, and less of the restorative slow-wave sleep. Bupropion reverses[7] those changes, while the SSRIs tend to make them worse.

It’s a paradox that the SSRIs can treat depression while worsening sleep quality.[8 ]They can also cause restless leg syndrome, something that bupropion can treat, according to a recent randomized controlled trial.[9,10]

On the other hand, bupropion does stand out among the antidepressants as having a positive effect on energy.11 When patients are up and active during the day, they are likely to sleep better at night. To me, activity level is a much more important outcome in depression than the amount of time it takes to fall asleep, so I won’t shy from choosing bupropion in a patient with insomnia.

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Dr Aiken is Instructor in Clinical Psychiatry at the Wake Forest University School of Medicine and the Director of the Mood Treatment Center in Winston-Salem, NC. He is Editor in Chief of The Carlat Psychiatry Reportand Section Editor for Psychiatric Times.

Dr Aiken does not accept honoraria from pharmaceutical companies but receives royalties from W.W. Norton & Co. for a book he co-authored with James Phelps, MD, Bipolar, Not So Much.